Toni Otto
San Antonio,Texas
Summary
Detail-oriented and results-driven Medical Billing Recovery Specialist with extensive experience in managing NGHP claims, including Medicare, liability, no-fault, and workers' compensation. Proficient in navigating complex Medicare Secondary Payer (MSP) guidelines, ensuring timely recovery of payments, and processing complex Medicare Secondary Payer (MSP) guidelines, ensuring timely recovery of payments, and processing redeterminations, appeals, and CPN validations and compliance with CMS regulations.
Overview
15
15
years of professional experience
Work History
Healthcare Billing Recovery Specialist 1 (SCA)
Performant Corp
Plantation, Florida
03.2023 - Current
- Proficient in handling redetermination appeals for CMS Non-Group Health Plan (NGHP) claims, ensuring adherence to Medicare guidelines and timelines.
- Skilled in navigating Medicare's NGHP redetermination process, contributing to successful claim resolutions and compliance with federal regulations.
- Assisted in onboarding and training new hires, ensuring smooth integration into team workflows and company procedures.
- Performed CPN (Conditional Payment Notice) validation to ensure accuracy of Medicare claims.
- Assist with A123 Audits
- Reviewed and validated HIGLAS payment data, ensuring correct allocation of funds and prompt resolution of discrepancies.
- Investigated and analyzed disputed claims, identifying errors and ensuring appropriate corrective action was taken.
Medical Billing Specialist
Progressive Medical Billing
San Antonio, TX
08.2022 - Current
- Entered procedure codes, diagnosis codes and patient information into Medisoft.
- Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
- Posted charges, payments and adjustments.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
Customer Service Associate
Circle K
San Antonio, Tx.
07.2018 - 01.2019
- Processed payments via cash, credit, and debit cards and counted back change to customers to avoid cash drawer errors
- Inspected identification to determine proper age of customers for alcohol and cigarettes
- Maintained high standards of job safety, productivity, and quality
- Provide exceptional customer service and enthusiasm when assisting customers
- Assisted in maintaining cleanliness of facility by reducing waste and cleaning task.
Customer service Associate
Circle K
Freeport, IL.
07.2015 - 08.2017
- Processed payments via cash, credit, and debit cards and counted back change to customers to avoid cash drawer errors
- Inspected identification to determine proper age of customers for alcohol and cigarettes
- Maintained high standards of job safety, productivity, and quality
- Provide exceptional customer service and enthusiasm when assisting customers
- Assisted in maintaining cleanliness of facility by reducing waste and cleaning task.
Assistant Store Manager
Super Pantry
Freeport, IL
12.2009 - 09.2014
- Assisted in overall day-to-day operations of store, including continuous development of effective store associates to achieve desired sales and results
- Completed frequent walk-through and directed team members to correct issues impacting store appearance or professionalism
- Handled scheduling for store shifts across a 7-day work week to achieve adequate staffing and delegated assignments to team members
- Received, checked-in and stocked merchandise throughout store, helped maintain store inventory levels and assisted with orderliness and cleanliness of sales floor, stock room, and walk-in cooler
- Tracked inventory, conducted cycle counts and audits and resolved issues to maintain accurate records
- Supervised cashiers in processing credit, debit, and cash payments to streamline sales.
Education
Medical Billing and Coding Certificates -
Southern Career Institute
San Antonio, Tx10.2022
High School Diploma -
Freeport Senior High School
Freeport, IL05.2003
Skills
- Employee management
- Verbal communication
- Customer service
- Product organization
- Data evaluation
- Problem-solving abilities
- Bill Payment
- Microsoft Office
- Error Revision
- Decision Making
- Medical Billing Processing
- Attention to Detail
- Knowledgeable in Medisoft Billing software
- ICD-10 Coding
- Microsoft Excel
- Redetermination appeals
- CPN validation Proficient
- Payments HIGLAS
Timeline
Healthcare Billing Recovery Specialist 1 (SCA)
Performant Corp
03.2023 - Current
Medical Billing Specialist
Progressive Medical Billing
08.2022 - Current
Customer Service Associate
Circle K
07.2018 - 01.2019
Customer service Associate
Circle K
07.2015 - 08.2017
Assistant Store Manager
Super Pantry
12.2009 - 09.2014
Medical Billing and Coding Certificates -
Southern Career Institute
High School Diploma -
Freeport Senior High School